Proportion Of Positive Agreement Research Articles

Arabic version of the Extended Nordic Musculoskeletal Questionnaire, cross-cultural adaptation and psychometric testing

BackgroundThe Extended Nordic Musculoskeletal Questionnaire (NMQ-E) had never been adapted into Arabic. We culturally adapted the NMQ-E to Arabic in five stages and investigated its psychometric properties.MethodsAfter translating and cross-culturally adapting the NMQ-E into Arabic, through forward translation, translation synthesis, backward translation, expert committee review, and pilot testing, the psychometric properties were investigated. The construct validity was assessed by having the participants completing the Arabic version of the NMQ-E with four Arabic scales that measured musculoskeletal pain in all regions covered in the NMQ-E. Participants’ baseline records were also used to evaluate internal consistency (Cronbach’s α). Seven days later, participants completed the Arabic NMQ-E again to evaluate its test–retest reliability employing intraclass correlation coefficient (ICC) and standard error of measurement (SEM) for the age questions, and Cohen’s kappa coefficient (κ), the proportion of observed agreement (Po), the proportion of positive agreement (Ppos), and the proportion of negative agreement (Pneg) for the dichotomous items.ResultsA total of 127 participants, 70 males and 57 females with mean age 32.5 ± 12.2 years, were included. Significant differences were found between participants with and without musculoskeletal pain in the corresponding scales, signifying the content validity of the questionnaire. Cronbach’s α for both the prevalence and consequences pain sections combined ranged from 0.30 to 1.00. The test–retest reliability of the age questions was excellent, with ICC values ranging between 0.995 and 1.00. The SEM was 0.77 for the neck region and 0 for the rest of the regions. The prevalence questions demonstrated almost perfect agreement, with κ values ranging between 0.82 and 1.00, the Po between 0.94 and 1.00, the Ppos between 0.80 and 1.00, and the Pneg between 0.93 and 1.00. The consequences of pain questions showed moderate-to-perfect agreement, with κ values ranging between 0.57 and 1.00, between 0.83 and 1.00 for the Po, between 0.50 and 1.00 for the Ppos, and between 0.86 and 1.00 for the Pneg.ConclusionsThe results suggest that the Arabic NMQ-E is a valid and reliable tool that can be used to screen Arab adults for the prevalence and consequences of musculoskeletal pain.

Suitability of Nasal and Deep Nasopharyngeal Swab Sampling of Calves in the Mycoplasma bovis Control Program.

Mycoplasma bovis is an important cattle pathogen affecting animal health, welfare, and productivity. The main disease syndromes are mastitis, pneumonia, and otitis media in young stock, as well as arthritis. Response to antibiotic treatment is poor and no effective vaccine is available. Asymptomatic carriers are common and usually harbor the organism in the airways or mammary glands. Purchase of carrier animals is a major risk for the introduction of infection into naive herds. Following the detection of M. bovis in Finland in 2012, a voluntary control program was established. It aims to prevent the spread of the infection and to help farms attain certification of a low M. bovis risk. Among the diagnostic tools in the program, nasal swabs (NS) from young calves have been tested for M. bovis to indicate the infection status of the herd. In this study, we assessed the suitability of this test method. We analyzed the effectiveness of NS and deep nasopharyngeal swabs (NP) to detect M. bovis in pneumonic and healthy calves in dairy herds recently infected with M. bovis. In pneumonic calves, NP sampling followed by culture and real-time PCR demonstrated a proportion of positive agreement (PPA) of 0.91 compared with bronchoalveolar lavage (BAL), whereas NS showed only 0.5 PPA compared with BAL. Among healthy dairy calves, overall M. bovis prevalence in NS was 29.6%. The highest rate of shedding (43%) occurred in calves 31–60 days old. At the calf level, M. bovis prevalence in NP samples was 47% compared with 33% in NS samples among the 284 studied calves. However, at the herd level, NS sampling classified 51 out of 54 herds with a positive infection status as infected, whereas in NP sampling, the respective figure was 43 out of 54 herds (p = 0.061). In conclusion, NS sampling from calves under 6 months of age and analyzed by real-time PCR is a cost-efficient method for a control program to detect M. bovis in dairy herds, even if no M. bovis mastitis has been detected in the herd. For pneumonic calves, we recommend only NP or BAL sampling.

Using Trigger Tool to detect incidents and adverse events in a mutual insurance company that collaborate with the Social Security system

To evaluate differences between the detection of incidents or adverse events (I/AE) using a Trigger Tool (TT) and voluntary notification platform (SNEA). The study population is the working population attended on an outpatient basis in an Insurance Company ("mutua") from January to September 2016. The cases declared as Incident or Adverse Event (I / AE) were selected through the SNEA (21 cases), according to whether the event has not affected the patient or on the contrary has affected him. On the other hand, 20 clinical histories per month were randomly selected where the TT was applied(180 cases). The 201 clinical histories were reviewed looking for the existence of triggers. The agreement between the SNEA system and the TT was evaluated using proportion of positive agreement (I/EA), proportion of negative agreement (not I/EA) and Kappa index. TT detected I/EA cases in 41.3% of the revisions while the SNEA was 10.3% (p<0.001). The Kappa index showed a low concordance value (Kappa = 0.12), which indicates the small coincidence of I/EA detected by both systems. The proportion of negative agreement was greater than that of positive agreement (74.5% versus 26.9%). The SNEA system detected less I/ EA and above all it deals with fewer incidents. On the contrary, the TT system detected a greater number of I EA and especially EA. Trigger Tool is a recommended tool for the detection of incidents or adverse events that can complement the one obtained through voluntary notification platform in the reality of a "mutua".

Urinary Ethyl Glucuronide Can Be Used as a Biomarker of Habitual Alcohol Consumption in the General Population

ABSTRACTBackgroundAlcohol consumption is a frequently studied risk factor for chronic diseases, but many studies are hampered by self-report of alcohol consumption. The urinary metabolite ethyl glucuronide (EtG), reflecting alcohol consumption during the past 72 h, is a promising objective marker, but population data are lacking.ObjectiveThe objective of this study was to assess the reliability of EtG as a marker for habitual alcohol consumption compared with self-report and other biomarkers in the general population.MethodsAmong 6211 participants in the Prevention of Renal and Vascular End-Stage Disease (PREVEND) cohort, EtG concentrations were measured in 24-h urine samples. EtG was considered positive when concentrations were ≥100 ng/mL. Habitual alcohol consumption was self-reported by questionnaire (categories: no/almost never, 1–4 units per month, 2–7 units per week, 1–3 units per day or ≥4 units per day). Plasma HDL cholesterol concentration, erythrocyte mean corpuscular volume (MCV), aspartate aminotransferase (AST), alanine aminotransferase (ALT), and γ-glutamyltransferase (GGT) were determined as indirect biomarkers of alcohol consumption. Sensitivity, specificity, positive and negative predictive value, and proportions of agreement between reported consumption and EtG were calculated. To test the agreement of EtG concentration and alcohol consumption in categories, linear regression analysis was performed. In addition, the association between EtG concentrations and indirect biomarkers was analyzed.ResultsMean age was 53.7 y, and 52.9% of participants men. Of the self-reported abstainers, 92.3% had an EtG concentration <100 ng/mL. Sensitivity was 66.3%, positive predictive value was 96.3%, and negative predictive value was 47.4%. The proportion of positive agreement was 78.5%, and the proportion of negative agreement was 62.7%. EtG concentrations were linearly associated with higher categories of alcohol consumption (P-trend < 0.001), adjusted for age, sex, and renal function. EtG was positively related to MCV, HDL cholesterol, and GGT but not to AST and ALT concentrations.ConclusionsThis study shows that urinary EtG is in reasonable agreement with self-reported alcohol consumption and therefore can be used as an objective marker of habitual alcohol consumption in the general population.

Human papillomavirus detection in matched oral rinses, oropharyngeal and oral brushings of cancer-free high-risk individuals

ObjectivesThe detection of oral Human Papillomavirus (HPV) may be of clinical utility because of the major role HPV plays in the etiology of oropharyngeal cancer. However, oral HPV testing is not standardized and the best sampling method has yet to be identified. We aimed to compare HPV findings in matched oral rinse-and-gargles (rinses), oropharyngeal brushings and oral brushings. Materials and methodsHPV-DNA was investigated using Linear Array in samples collected from cancer-free individuals at increased risk for oral HPV. Results163 oral rinses already tested for HPV were selected. The matched oropharyngeal (n = 163) and oral brushings (n = 100) were analyzed. The detection rate for any HPV, high-risk (HR)-HPVs and HPV16 was significantly higher in rinses than brushings. The overall agreement for any HPV between rinses and oropharyngeal brushings was 51.2% (Cohen K: 0.14, 95% CI: 0.07–0.21). The proportion of positive agreement was 16.8%. The overall agreement for HR-HPVs was 74.1% (Cohen K: 0.20, 95% CI: 0.07–0.33). The genotype-specific profile of rinses and brushings which were concomitantly HPV-positive only partially overlapped in cases with multiple infections, with more genotypes detected in the rinse, which were not isolated in the corresponding brushings. ConclusionThe agreement for HPV status between rinses and brushings is poor, particularly for the HPV-positive findings. Despite the fact that the origin of the HPV-infected cells present in the oral rinse is unclear, since they could not be traced back to the oropharynx or oral cavity, oral rinses provided the highest detection rate for HR-HPVs and HPV16.

DRC Is Not Ready for Transition from Anonymous Unlinked Sero-surveillance to Using PMTCT Program Data for HIV Surveillance, According to the WHO Criteria Assessment Results

Since 2003, the Democratic Republic of Congo (DRC) has carried on HIV surveillance through Anonymous Unlinked Testing in Sentinel Surveillance sites (AUT-SS) amongst pregnant women attending Antenatal Clinics (ANC). However, this expensive process raises ethical limitations. In 2013, the World Health Organization (WHO) recommended countries to evaluate the possibility of transitioning from the AUT-SS to surveillance based on data from the routine diagnosis of HIV in Prevention of Mother-To-Child Transmission (PMTCT) programs. The authors carried out this evaluation for DRC. An evaluation of four of the five criteria proposed by the WHO was conducted by following the defined procedure, and comparing with the determined benchmarks, to assess whether DRC can undergo the transition. Data for this assessment were collected in 2013 and 2015 during sentinel surveillance activities. AUT- SS data of 26,301 pregnant women were collected from 60 sentinel sites, while data from PMTCT routine testing were available for 12,291 women. The overall rate of agreement between routine PMTCT and AUT-SS test results (Cohen's Kappa coefficient of agreement) was 0.7% (95% CI: 0.65 - 0.76%), the proportion of positive agreement (PPA) was 65.7% (95% CI: 59.8%-71.1%), and the proportion of negative agreement (PNA) was 99.5% (95% CI: 99.4%-99.7%). The level of non-consent bias in the routine screening test was 4.8%, with a ratio of difference in prevalence of 1 to 10. Eighty-three per cent of sentinel surveillance sites also offered PMTCT service, which was discontinued for 34% of them. DRC must still strengthen the robustness of routine HIV testing, the overall rate of access to this test, its permanence/regularity, and the quality of the data collected in routine, before claiming to use the data from the PMTCT program for purposes of HIV surveillance, in lieu of the ANC AUT- SS.

Limited Agreement on Etiologies and Signs/Symptoms among Registered Dietitian Nutritionists in Clinical Practice

BackgroundClinical studies that establish the reliability and validity of nutrition diagnoses are absent from the literature. ObjectiveThe purpose of this study was to assess the reliability and validity of the diagnoses, etiologies, and signs/symptoms within the clinical practice of registered dietitian nutritionists (RDNs). DesignNine pairs of RDNs randomly selected adult patients to diagnose. The two RDNs in each pair independently assessed nutritional data from the same patient. Each RDN chose one nutrition diagnosis and rated the presence or absence of the etiologies and signs/symptoms. Clinical reliability was determined with percentage of agreement for the diagnoses, and percentage agreement, kappa coefficient, and the proportions of positive agreement (ppos) and negative agreement (pneg) for the etiologies and signs/symptoms. Clinical validity was calculated according to a clinical diagnostic validity score for etiologies and signs/symptoms. ResultsThese RDNs practiced either in an acute-care facility (n=10; 58.8%), ambulatory/outpatient facility (n=3; 17.6%), or both (n=4; 23.5%). Nutrition diagnoses were selected for 316 patients. Two raters selected the same diagnosis for 121 patients (38% agreement). Agreement was moderate (κ=0.54) for etiologies and at the lower end of substantial (κ=0.63) for signs/symptoms. For etiologies ppos=0.71 and pneg=0.78 and for signs/symptoms ppos=0.82 and pneg=0.79, indicating that the raters agreed on the presence of each as well as the absence. The overall clinical diagnostic validity score for etiologies was 0.33 and for signs/symptoms was 0.44, signifying they were not characteristic of the diagnoses. ConclusionsAlthough RDNs knew a nutrition problem was present, they were in poor agreement as to the most important diagnosis, etiologies, and signs/symptoms. The lack of agreement indicated inconsistencies in determining a primary diagnosis among these RDNs.

Home visits to assess the reliability of caregiver-reported use of insecticide-treated bednets by children in Machinga District, Malawi.

A malaria cohort study was conducted among young children in Machinga District, Malawi, following distribution of insecticide-treated bednets (ITNs) in May 2012. To assess ITN use, two independently sampled subsets of children (211 during survey 1 [December 2012-January 2013] and 325 during survey 2 [September-October 2013]) were randomly selected to compare the proportions of positive and negative agreement between caregiver verbal reports at monthly interviews with visual observation of the ITN at home visits. Caregiver-reported ITN use was consistently high during both surveys (98.1% and 96.0%, respectively; P = 0.17). Home visit-based ITN use fell significantly (P < 0.001) from survey 1 (98.6%) to survey 2 (88.6%). The proportions of positive agreement between caregiver report and home visit in the first and second surveys were 98.8% (95% confidence interval [CI] 97.6-99.8%) and 93.3% (95% CI 91.2-95.3%), respectively. The proportions of negative agreement in the first and second surveys were 28.6% (95% CI 0-75.0%) and 20.0% (95% CI 0.1-35.0%), respectively. ITN use by children was high in Machinga District, and caregiver reports and home visits with visual confirmation of the net demonstrated a high level of agreement for use of ITNs, but a low level of agreement when ITNs were not used.

Concordance studies between hospital discharge data and medical records for the recording of lower extremity amputation and diabetes in the Republic of Ireland.

BackgroundHospital discharge data have been used to study trends in Lower Extremity Amputation (LEA) rates in people with and without diabetes. The aim of this study was to assess the reliability of routine hospital discharge data in the Republic of Ireland (RoI) for this purpose by determining the level of agreement between hospital discharge data and medical records for both the occurrence of LEA and diagnosis of diabetes.MethodsTwo concordance studies between hospital discharge data (HIPE) and medical records were performed. To determine the level of agreement for LEA occurrence, HIPE records were compared to theatre logbooks in 9 hospitals utilising HIPE over a two-year period in a defined study area. To determine the level of agreement for diabetes diagnosis, HIPE records were compared to laboratory records in each of the 4 largest hospitals utilising HIPE over a one week period in the same study area. The proportions of positive and negative agreement and Cohen’s kappa statistic of agreement were calculated.ResultsDuring a two-year study period in 9 hospitals, 216 LEAs were recorded in both data sources. Sixteen LEAs were recorded in medical records alone and 25 LEAs were recorded in hospital discharge records alone. The proportion of positive agreement was 0.91 (95% CI 0.88-0.94), the proportion of negative agreement was 0.99 (95% CI 0.98-0.99) and the kappa statistic was 0.91 (95% CI 0.88-0.94).During a one-week study period in 4 hospitals, 49 patients with diabetes and 716 patients without diabetes were recorded in both data sources. Eighteen patients had diabetes in medical records alone and 2 patients had diabetes in hospital discharge records alone. The proportion of positive agreement was 0.83 (95% CI 0.76-0.9), the proportion of negative agreement was 0.99 (95% CI 0.98-0.99) and the kappa statistic was 0.82 (95% CI 0.75-0.89).ConclusionsThis study detected high levels of agreement between hospital discharge data and medical records for LEA and diabetes in a defined study area. Based on these findings, we suggest that HIPE is sufficiently reliable to monitor trends in LEAs in people with and without diabetes in the RoI.

Development and Initial Validation of a Patient-Reported Adverse Drug Event Questionnaire

Direct patient reporting of adverse drug events (ADEs) is relevant for the evaluation of drug safety. To collect such data in clinical trials and postmarketing studies, a valid questionnaire is needed that can measure all possible ADEs experienced by patients. Our aim was to develop and test a generic questionnaire to identify ADEs and quantify their nature and causality as reported by patients. We created a draft list of common ADEs in lay-terms, which were classified in body categories and mapped to the Medical Dictionary for Regulatory Activities (MedDRA(®)) terminology. Questions about the nature and causality were derived from existing questionnaires and causality scales. Content validity was tested through cognitive debriefing, revising the questionnaire in an iterative process. Feasibility and reliability were assessed using a Web-based version of the questionnaire. Patients received the questionnaire twice. Feasibility was assessed by the reported time needed for completion and ease of use. Reliability was calculated using Cohen's kappa and proportion of positive agreement (PPA) on: (1) any ADE at patient level; (2) similar ADEs at MedDRA(®) System Organ Class level; and (3) the same ADE at ADE-specific level. In the development phase, 28 patients with type 2 diabetes or asthma/chronic obstructive pulmonary disease (COPD) participated. Questions and answer options were rephrased, layout was improved, and changes were made in the classification of ADEs. The final questionnaire consisted of 252 ADEs organized in 16 body categories, and included 14 questions per reported ADE. A total of 135 patients using a median of five different drugs completed the Web-based questionnaire twice. The median completion time was 15 min for patients not reporting any ADE, and 30 min for patients reporting at least one ADE. Three quarters of the patients found the questionnaire easy to use. Test-retest reliability was acceptable at patient level (κ = 0.50, PPA 0.64) and at MedDRA(®) System Organ Class level (κ = 0.52, PPA 0.54), but was low at ADE-specific level (κ = 0.38, PPA 0.38). We developed a generic patient-reported ADE questionnaire and confirmed its content validity. The questionnaire was feasible and reliable for reporting any ADE and similar ADEs at MedDRA(®) System Organ Class level. Additional work is, however, needed to reliably quantify specific ADEs reported by patients.

Are self-report of disability pension and long-term sickness absence accurate? Comparisons of self-reported interview data with national register data in a Swedish twin cohort

BackgroundSelf-reported disability pension (DP) and sickness absence are commonly used in epidemiological and other studies as a measure of exposure or even as an outcome. The aims were (1) to compare such self-reports with national register information in order to evaluate the validity of self-reported DP and sickness absence, and (2) to estimate the concordance of reporting behaviour in different twin zygosity groups, also by sex.MethodsAll Swedish twins born 1933-1958 who participated in the Screening Across the Lifespan Twin study (SALT) 1998-2003, were included (31,122 individuals). The self-reported DP and long-term sickness absence (LTSA) at the time of interview was compared to the corresponding register information retrieved from the National Social Insurance Agency by calculating the proportions of agreements, kappa, sensitivity, specificity, concordance rates, and chi-square test, to evaluate construct validity.ResultsThe proportions of overall agreement were 96% and specificity 99% for both DP and LTSA, while the sensitivity was 70% for DP and 45% for LTSA. Kappa estimates were 0.76 for DP, and 0.58 for LTSA. The proportions of positive agreement were 64% for DP and 42% for LTSA. No difference in response style was found between zygosity groups among complete twin pairs for DP and LTSA. Results were similar for women and men and across age. Kappa estimates for DP differed somewhat depending on years of education, 0.68 (college/university) vs. 0.77 (less than 13 years in school) but not for LTSA.ConclusionsSelf-reported DP data may be very useful in studies when register information is not available, however, register data is preferred especially for LTSA. The same degree of twin similarity was found for truthful self-report of DP and LTSA in both monozygotic and dizygotic twin pairs. Thus, the response style was not influenced by genetic factors. One consequence of this would be that when estimating the relative importance of genetic and environmental effects from twin models, heritability estimates would not be biased.

Clinician versus nurse symptom reporting using the National Cancer Institute—Common Terminology Criteria for Adverse Events during chemotherapy: results of a comparison based on patient's self-reported questionnaire

BackgroundMonitoring adverse events during chemotherapy by clinicians is a standard practice but clinicians may report fewer side-effects or lower symptom severity than patients. Our aim was to compare symptoms self-reported by patients with symptoms registered by clinicians and nurses, to assess validity of a nurse reporting. MethodsFrom April to August 2007, a double-blind questionnaire with 13 common items graduated according to the National Cancer Institute's Common Terminology Criteria for Adverse Events was completed by clinicians and nurses for outpatients undergoing chemotherapy at our Medical Oncology Day Hospital Unit. Patients completed a modified questionnaire with simplified terms. They were requested to specify seriousness of symptoms with a subjective scale varying from 1 to 4. Every patient–nurse–clinician questionnaire was registered for the statistical analysis. Agreement was evaluated by Cohen's kappa coefficient. ResultsEighty-five paired questionnaires were completed. Patients, nurses and clinicians agreed on most symptoms and toxicity grade. Agreements between patients and nurses were stronger than those between patients and physicians for the six most common symptoms: asthenia (kappa 75% versus 37%), constipation (83% versus 45%), neuropathy (82% versus 55%), mucositis (78% versus 46%) and diarrhoea (90% versus 77%). These differences mainly reflected differences in the proportion of positive agreement: nurses were more able to detect symptoms self-reported by patients than physicians. The only exception was nausea, as kappa coefficient was very good for both health professionals (91% versus 89%). When considering the different grade of toxicity by the weighted kappa coefficient, we scored again the highest agreement between patient and nurse, with weighted kappa ranging from 55% (asthenia) to 86% (diarrhoea), and the lowest agreement between patient and physician, with weighted kappa ranging from 32% (asthenia) to 74% (nausea). The agreement between physician and nurse slightly improved, with weighted kappa ranging from 41% (constipation) to 77% (nausea). ConclusionOur results support the validity of nurse toxicity reporting and that the nurse staff could be successfully employed in collecting toxicity data because of a greater ability to elicit information from patients than the medical staff.

Validez del diagnóstico presuntivo de leishmaniasis cutánea realizado por mediadores comunitarios en Colombia

To validate a method for the presumptive diagnosis of cutaneous leishmaniasis based on the observation of clinical-epidemiological criteria, carried out by community health workers in three endemic municipalities in Santander, a department in northeastern Colombia. This evaluation study of diagnostic technologies was based on a cross-sectional sampling of suspected cases of cutaneous leishmaniasis in the municipalities of Rionegro, El Playón, and Landázuri. After being trained, the community health workers carried out the presumptive diagnoses of cutaneous leishmaniasis between October 2004 and November 2005. At the time of diagnosis, the health workers also collected samples for confirmatory diagnosis through Field's stain method, culturing, and polymerase chain reaction. Four criteria were used to assess the validity of the presumptive diagnoses carried out by the health workers: sensitivity, specificity, positive predictive value, and negative predictive value. Replicability among the health workers was estimated through their observed level of agreement. According to the laboratory tests, of the 196 patients studied, 33 (16.8%) were negative and 163 (83.2%) were positive. For all the levels of certainty of the clinical diagnosis, the sensitivity was between 52% and 98% (kappa(1, 0) = 39.0%) and the specificity between 9% and 55% (kappa(0, 0) = 14.0%). The area under the receiver operating characteristic curve was 56.5% (95% confidence interval: 45.6% to 67.4%). The proportion of positive agreement and of negative agreement was 86.3% and 43.5%, respectively. The sensitivity of the presumptive diagnosis carried out by the health workers surpasses that of the parasitological diagnostic methods generally used in the three endemic areas, but its specificity is much lower. Even though this approach is not useful as a diagnostic test for cutaneous leishmaniasis or as a criterion for deciding to proceed with treatment or not, the method is useful for the active identification of cases in the community.

Evaluation of expressed emotion (EE) status in mood disorders in Japan: inter-rater reliability and characteristics of EE

The reliability of expressed emotion (EE) ratings by the Camberwell Family Interview (CFI) and characteristics of EE were evaluated in families of patients with mood disorders in Japan. The subjects were 27 patients with mood disorders and 31 members of their families. The CFI was carried out with the family members. EE was rated by two raters independently, and the inter-rater reliability was evaluated according to Spearman’s correlation coefficient by ranks and the κ-value. The distribution of subscales of EE in these subjects was compared with that in families of patients with schizophrenia in Japan and families of patients with mood disorders abroad. Concerning critical comments (CC), hostility (H), and emotional over-involvement (EOI), which are important for EE rating, Spearman’s correlation coefficient and the κ-values were 0.4–0.8, and the reliability of EE ratings in mood disorders was not high. The proportion of positive agreement was particularly low in H and EOI. CCs were fewer in families of Japanese patients with mood disorders than in those with schizophrenia or families of American or European patients with mood disorders. Re-evaluation of the inter-rater reliability of EE ratings in mood disorders is needed. Expressed emotion was more suppressed in families of patients with mood disorders than in those of patients with schizophrenia. Expressed emotion was also more reserved in the Japanese subjects than in their Western counterparts.

Gender and intra-observer agreement about laryngoscopy of papilloma

Background: The gender of the observer may bias data. Objective: Compare the intra-observer agreements of male and female pediatric otolaryngologists about videotaped images of laryngeal papilloma. Design: Five male and six female pediatric otolaryngologists independently viewed videotapes of ten children undergoing treatment for laryngeal papilloma. Each of 12 anatomic sites was categorized as disease present, absent, or indeterminate. Each observer estimated the percent overall airway obstruction. 5–24 weeks later, each observer repeated his/her assessments. Results: The mean intra-observer agreements for both male and female pediatric otolaryngologists were good, and identical ( κ 0.63; proportion of positive agreement 0.82; proportion of negative agreement 0.72). Females more frequently categorized a site as indeterminate. Males more frequently categorized a site oppositely on repeat assessment. The males’ indeterminate/opposite ratio was less than that of the females’ ( P=0.03). Intra-observer estimates of overall airway obstruction have wide variability: for male pediatric otolaryngologists, differences exceeding 30% are significant; for females, 40%. Conclusions: Male and female pediatric otolaryngologists had equally good and identical intra-observer κ scores and proportions of positive and negative agreement. However, males used the indeterminate category less than did the females, and males more often gave an opposite categorization at the second viewing session. Estimates of overall airway obstruction have much intra-observer variability.

War induced posttraumatic stress disorder in out patient psychiatric treatment

The reliability of expressed emotion (EE) ratings by the Camberwell Family Interview (CFI) and characteristics of EE were evaluated in families of patients with mood disorders in Japan. The subjects were 27 patients with mood disorders and 31 members of their families. The CFI was carried out with the family members. EE was rated by two raters independently, and the inter-rater reliability was evaluated according to Spearman’s correlation coefficient by ranks and the κ-value. The distribution of subscales of EE in these subjects was compared with that in families of patients with schizophrenia in Japan and families of patients with mood disorders abroad. Concerning critical comments (CC), hostility (H), and emotional over-involvement (EOI), which are important for EE rating, Spearman’s correlation coefficient and the κ-values were 0.4–0.8, and the reliability of EE ratings in mood disorders was not high. The proportion of positive agreement was particularly low in H and EOI. CCs were fewer in families of Japanese patients with mood disorders than in those with schizophrenia or families of American or European patients with mood disorders. Re-evaluation of the inter-rater reliability of EE ratings in mood disorders is needed. Expressed emotion was more suppressed in families of patients with mood disorders than in those of patients with schizophrenia. Expressed emotion was also more reserved in the Japanese subjects than in their Western counterparts.